Provider Demographics
NPI:1114645009
Name:PODER HEALING LLC
Entity Type:Organization
Organization Name:PODER HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LICENSED THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ALEXMI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:646-470-0639
Mailing Address - Street 1:5030 BROADWAY STE 630
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1611
Mailing Address - Country:US
Mailing Address - Phone:646-470-0639
Mailing Address - Fax:516-490-7472
Practice Address - Street 1:5030 BROADWAY STE 630
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1611
Practice Address - Country:US
Practice Address - Phone:646-470-0639
Practice Address - Fax:516-490-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty